Walking the walk

In March 2018, the Human Rights Campaign (HRC), an advocacy organization dedicated to improving the lives of LGBTQ people, released its 11th Annual Healthcare Equality Index. The HEI is an indicator of how inclusive and equitable health care facilities are in providing care for their LGBTQ patients. My own institution, Children’s Hospital of Pittsburgh, scored very high on this index and received the “Leader in LGBTQ Healthcare Equality” designation. The process of receiving this designation is very rigorous, and I am proud of my institution for making great strides in expanding health care access for LGBTQ patients, especially transgender patients. However, this is no time to rest on one’s laurels, as many transgender people still experience challenges and barriers in navigating the health care system.

AlexRaths/Thinkstock

Disparities in health outcomes between transgender and nontransgender people is well known, and some of these discrepancies can be attributed to difficulty in accessing high-quality health care. The biggest barrier is finding a health care provider who is culturally competent in delivering health care to transgender patients. Many transgender individuals expect rejection and discrimination everywhere they go,1 and health care institutions are no exception. For example, about one-fifth of transgender individuals report being denied health care at their primary care provider because of the person’s gender identity and/or gender expression.2 Even if they’re not rejected outright, many transgender patients often are misgendered by health care staff, or they find themselves educating the provider on transgender health issues.2 Even transgender individuals who find a provider who is competent in providing transgender health care still experience additional barriers. For example, EHRs often do not list gender identity and/or pronouns in the chart. This makes it more likely for providers to misgender patients by mistake because they only have the EHR as a reference.

Insurance access continues to be a problem. I wrote a column in June 2017 about obtaining health care insurance for transgender patients. Preauthorization is common for obtaining cross-sex hormones or pubertal blockers even for insurance companies that are willing to pay for them – a process that can take weeks, even months, to complete. This creates delays in obtaining necessary care for transgender patients. This is just one of the many barriers transgender people face in navigating the health care system.

Increasing access to health care services for transgender patients is more about improving health outcomes than patient satisfaction. Even the smallest policy change may have a meaningful impact on the lives of transgender individuals. A study by Russell et al., in the April 2018 issue of Journal of Adolescent Health found that transgender youth allowed to use their chosen name (instead of the name assigned to them by their parents at birth) were more likely to have fewer depressive symptoms and lower rates of suicidal ideation and suicidal behavior.3 These findings highlight that even a small change can have a huge impact on the health and well-being of this patient population.